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Contraceptive Tier Exception Request for Providers

You may want to prescribe a medication or another FDA-approved contraceptive agent that is not covered under Florida Blue’s prescription formulary/medication guide.

If this is the case, either you or the member can request an exception by submitting a Contraceptive Tier Exception Request.

How to submit a Contraceptive Tier Exception Request for medications or other contraceptive agents under a pharmacy benefit:

Prime Therapeutics will review and then approve or deny your Contraceptive Tier Exception Request within 72 hours (urgent requests) or 15 calendar days (non-urgent requests). We’ll notify you and the member with the result by letter.

If the request is denied, you or the member can appeal. To do so, submit a completed appeal form based on your benefit. Please allow 30 days for appeals to be reviewed.

Have questions? Call us at 1-800-727-2227.

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